This post is prompted by Lean Blog: Sports, a book that collects together some of his blog posts on Lean and sports. These posts fall into two categories. Some are posts either by him or by a guest blogger on lean processes within sports. These are enjoyable, but the more relevant posts for health and social care services are posts in which he uses some aspect of sport to illuminate Lean principles.
I was struck by two issues: his views on leadership, and on the nature of added value.
On leadership, Mark devotes several posts to considering leadership styles. He notes W. Edward Deming’s view that one of the actions required in good management is to ‘drive out fear’. He contrasts this with the ‘management by threat’ practiced by some sports coaches, and which can be encountered in health services. This also relates to Toyota’s emphasis on respect for people. If coaches (or managers) browbeat staff, and constantly emphasise their perceived superiority over them, it’s then difficult to engage them in improving the quality of their own work. Who can admit to a problem if it is seen as a personal weakness that deserves punishment?
Graban is not arguing that staff should not be confronted, or that managers should ‘go easy” with them. Toyota refer to mutual trust and mutual responsibility, which seems very relevant to health and social care settings. Staff need to be given freedom to identify and resolve problems: if they aren’t worth the respect implicit in working with them in an adult to adult manner, then it’s unlikely they will feel any power to change how they work. The flip side of this is that it implies an obligation to take part in quality improvement processes.
The other example that struck me was on added value. Lean emphasises the reduction in waste, or muda. Waste is an activity that doesn’t add value. As Mark Graban points out, the key issue is to first define value.
Who decides what value is in a health service? Graban gives the example of being able to boil a sports event down to a few minutes highlights. This doesn’t mean that those who attended in person accrued no value from it. The atmosphere, the feeling of being involved, meeting with friends – all these might be a core part of the value for a person.
There’s unlikely to be much value in waiting, but other decisions on the nature of waste in health services may be less obvious. If a nurse spends extra time with a patient in order to involve them in decisions on their own care, is that waste? Almost certainly not.
Do you have a view on the nature of waste in mental health services?
Photo courtesy of tungphotos at freedigitalphotos.net